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RATIONALE: Pharmacological treatments for depression are not always effective and produce unwanted side effects. Male and female sexual dysfunction is one of these side effects, which can lead to treatment withdrawal. Combination of two antidepressants with different mechanisms of action, like mirtazapine (MTZ) and venlafaxine (VLF) have been shown to be effective for treatment-resistant depression in humans. Combination of low doses of these drugs may still exert antidepressant-like effects without altering sexual behavior. OBJECTIVES: To investigate the potential antidepressant-like effect of the chronic administration of low doses of MTZ plus VLF combined, as well as its impact on male and female sexual behavior in rats. METHODS: The antidepressant-like effect of a 14-day treatment with combinations of MTZ plus VLF (0/0, 2.5/3.75 or 5/7.5 mg/kg) was assessed in young adult male and female rats in the forced swim test (FST). The 5/7.5 mg/kg MTZ/VLF combination was also tested in the chronic mild stress (CMS) test, in both males and females treated for 21 days. The sexual effects of this last treatment were assessed in sexually experienced males and in gonadally-intact females during proestrus. RESULTS: The 5/7.5 mg/kg MTZ/VLF combination produced an antidepressant-like effect in the FST and reversed the CMS-induced anhedonia in both male and female rats. This combination did not alter male sexual behavior, female proceptive and receptive behaviors or the regularity of the estrous cycle. CONCLUSION: The combination of low doses of MTZ and VLF might be a promising therapeutic alternative to treat depression without affecting the sexual response.

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Restructuring an aging face from bone structure to the surface of the skin can be metaphorically compared to building and renovating a house. While each anatomical layer of the face undergoes an aging process of its own, there is also an interdependency of superficial structures on deeper layers, so that a change in one layer may lead to changes to the adjacent layers. This interaction among the structures deep into the skin, along with the skin's ability to envelope them is what determine the aspect of the aging face. Thus, a careful assessment of all the layers is imperative and we describe herein a step-by-step facial layering assessment and facial restructuring approach from bone structure to the surface of the skin to implement a treatment plan able to deliver a harmonious rejuvenating outcome.

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In this research, the decomposition of toxic organics from pulp and paper mill effluent by the sequential application of ozonation and biodegradation was studied. Ozonation, as a pre-treatment, was executed to transform the initial pollutants into less toxic compounds (such as organic acids of low molecular weights). Biodegradation was executed during three days with acclimated microorganisms that were able to complete the decomposition of the initial organic mixture (raw wastewater) and to achieve a higher degree of mineralization (85-90%). Experiments were performed under three different conditions: (a) only ozonation of the initial contaminants, (b) only biodegradation of residual water without previous treatment by ozone and (c) ozonation followed by biodegradation performed by acclimated microorganisms. In the case of 72 h of biodegradation, the mineralization efficiency reached 85% and 89% after 30 and 60 min of ozonation, respectively. The no significant difference in this parameter coincided with the calculated generalized microorganisms' consortia specific growing rate µmax that was reduced from 2.08 × 10-3 h-1 to 6.05 × 10-4 h-1 when the ozonation time was longer. The identification of the organics composition by gas chromatography with mass detector (GC-MS) before and after treatments confirmed that the proposed combined process served as a more efficient alternative to secondary and tertiary treatments (mineralization degree between 60 and 80% in average) of the paper industry wastewater.

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Introducción: Los schwanomas vestibulares son lesiones clasificadas como grado I por la Organización Mundial de la Salud. Las opciones conductuales incluyen la observación, la radiocirugía o la resección microquirúrgica endoscópica. Objetivo: Describir el rol del tratamiento multimodal en los schwanomas vestibulares. Métodos: Se realizó una búsqueda sistemática de literatura médica para la identificación e inclusión de artículos en las siguientes bases de datos: PubMed/Medline, SciELO y Google Scholar, además de los servidores de preprints BioRvix y MedRvix. Se usaron los siguientes descriptores: vestibular schwanoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Se excluyeron editoriales, cartas al editor, libros, revisiones, metaanálisis y aquellos artículos con método deficiente de más de 20 años de publicación o sin mención al tema de interés. Fueron incluidos 16 artículos. Desarrollo: Los artículos incluyeron un total de 699 pacientes, de los cuales solo 228 (32,6 porciento) recibieron radioterapia en el período posoperatorio. El período de seguimiento promedió 49,6 meses. La preservación de la función facial se logró en el 88,3 porciento de los casos y el control tumoral en el 80,7 porciento. El estado de la preservación auditiva solo fue informado en el 50 porciento de los estudios. El uso de la radioterapia adyuvante mostró gran variabilidad. Conclusiones: El tratamiento multimodal para los schwanomas vestibulares grandes -compuesto por la resección subtotal, vaciamiento intratumoral, seguido de radiocirugía- se ha convertido en una opción plausible. Se necesita la publicación de mayor cantidad de reportes para ofrecer recomendaciones y estratificar la conducta(AU)

Introduction: Vestibular schwannomas are lesions classified as grade I by the World Health Organization. Behavioral options include observation, radiosurgery or endoscopic microsurgical resection. Objective: To describe the role of multimodal treatment for vestibular schwannomas. Methods: A systematic search of medical literature, for the identification and inclusion of articles, was carried out in the databases PubMed/Medline, SciELO and Google Scholar, as well as in the preprint servers BioRvix and MedRvix. The following descriptors were used: vestibular schwannoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Editorials, letters to the editor, books, reviews and metaanalyses were excluded, as well as articles with deficient method of more than 20 years of publication or not mentioning the topic of interest. Sixteen articles were included. Development: The articles included a total of 699 patients, of which only 228 (32.6 ) received radiotherapy in the postoperative period. The average follow-up period was 49.6 months. Preservation of facial function was achieved in 88.3 percent of cases; and tumor control, in 80.7 percent. Hearing preservation status was reported in only 50 percent of the studies. The usage of adjuvant radiotherapy showed great variability. Conclusions: Multimodal treatment for large vestibular schwannomas -composed of subtotal resection and intratumoral draining, followed by radiosurgery- has become a plausible option. The publication of a greater amount of reports is necessary to provide recommendations and stratify the behavior(AU)

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BACKGROUND: Melanoma is a highly metastatic skin cancer with limited response to current therapies in advanced patients. To overcome resistance, novel treatments based on photodynamic and photothermal therapies (PDT and PTT, respectively) have been developed to treat melanoma in preclinical murine models. Despite success inhibiting implanted tumors' growth, there has been limited evaluation of their long-term effectiveness in preventing metastasis, recurrence, or improving survival rates. METHODS: Combined and multidrug therapies based on PDT and/or PTT to treat cutaneous malignant melanoma in the preclinical mouse model were reviewed from 2016 onwards. PubMed® was the database in which the search was performed using mesh search algorithms resulting in fifty-one studies that comply with strict inclusion rules of screening. RESULTS: B16 melanoma-bearing C57BLACK6 mice model was the most used to evaluate immunotherapies, chemotherapies, and targeted therapies in combination with PDT and/or PTT. Combined therapies demonstrated a synergistic effect, resulting in intense antitumor activity. The most extensively studied protocol for developing metastatic models involved the intravenous administration of malignant cells, with some combined therapies being tested. Furthermore, the review presents the composition of the nanostructures utilized for delivering the drugs and light-responsive agents and the treatment plans for each combined approach. CONCLUSIONS: The identified mechanisms to simulate metastatic melanoma models and the therapeutic combinations may aid in evaluating the systemic protection of combined PDT and PTT-based therapies, particularly in conducting short-term preclinical experiments. Such simulations could have relevance to clinical studies.

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Chemotherapy or involvement in a clinical trial remain the standard treatment for patients with EGFR mutant non-small cell lung cancer who have disease progression while receiving Osimertinib. Rapid progression, also known as flare-phenomenon, has been described after discontinuation of tyrosine kinase inhibitors. In this case, we describe a young woman who has extracranial progressive disease due to EGFR C797S resistance mutation while being treated with osimertinib, with a rapid neurological deterioration after osimertinib withdrawal due to flare-phenomenon progression in the brain, and a prompt intracranial response with osimertinib reintroduction in addition to chemotherapy to achieve extracranial diseases control.

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Chagas disease (CD), a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi, is an important public health problem mainly in Latin America, leading to approximately 12,000 annual deaths. Current etiological treatment for CD is limited to two nitro compounds, benznidazole (Bz) and nifurtimox (Nif), both presenting relevant limitations. Different approaches have been employed to establish more effective and safer schemes to treat T. cruzi infection, mostly based on drug repurposing and combination therapies. Amiodarone (AMD), an antiarrhythmic medicament of choice for patients with the chronic cardiac form of CD, is also recognized as a trypanocidal agent. Therefore, our aim is to investigate the combined treatment Bz + AMD on trypomastigote viability, control of T. cruzi intracellular form proliferation, and recovery of the infection-induced cytoskeleton alterations in cardiac cells. The combination of Bz + AMD did not improve the direct trypanocidal effect of AMD on the infective blood trypomastigote and replicative intracellular forms of the parasite. Otherwise, the treatment of T. cruzi-infected cardiac cells with Bz plus AMD attenuated the infection-triggered cytoskeleton damage of host cells and the cytotoxic effects of AMD. Thus, the combined treatment Bz + AMD may favor parasite control and hamper tissue damage.

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Prions are proteins that cause fatal neurodegenerative diseases. The misfolded conformation adopted by prions can be transmitted to other normally folded proteins. Therapeutics to stop prion proliferation have been studied experimentally; however, it is not clear how the combination of different types of treatments can decrease the growth rate of prions in the brain. In this article, we combine the implementation of pharmacological chaperones and interferons to develop a novel model using a non-linear system of ordinary differential equations and study the quantitative effects of these two treatments on the growth rate of prions. This study aims to identify how the two treatments affect prion proliferation, both individually and in tandem. We analyze the model, and qualitative global results on the disease-free and disease equilibria are proved analytically. Numerical simulations, using parameter values from in vivo experiments that provide a pharmaceutically important demonstration of the effects of these two treatments, are presented here. This mathematical model can be used to identify and optimize the best combination of the treatments within their safe ranges.

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PURPOSE: This paper aims to observe the expressions of VEGF and MMP-2 in patients with nasopharyngeal carcinoma treated by nimotuzumab combined with cisplatin. METHODS: Altogether, 104 patients with nasopharyngeal carcinoma treated in our hospital from April 2014 to August 2016 were selected as research subjects. Among them, 50 patients treated with cisplatin were divided into a control group and 54 patients treated with nimotuzumab combined with cisplatin were divided into an observation group. The two groups of patients were compared in terms of efficacy after treatment and incidence of adverse reactions. Changes of serum VEGF and MMP-2 concentrations before and after treatment were detected using enzyme-linked immunosorbent assay (ELISA), and the 3-year overall survival (OS) of patients was observed. RESULTS: Compared with the control group, patients in the observation group had significantly higher total remission rate (RR) (P < 0.05) and significantly lower incidence of adverse reactions (P < 0.05). Before treatment, there was no significant difference between the observation and control groups in the concentrations of VEGF and MMP-2 (P > 0.05). After treatment, the concentrations in the two groups were significantly lower than those before treatment (P < 0.05), and the concentrations in the observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the 3-year OS between the observation and control groups (P > 0.05). CONCLUSIONS: Nimotuzumab combined with cisplatin could improve the conditions of patients with nasopharyngeal carcinoma. After treatment, the expression of VEGF and MMP-2 decreased significantly. We speculated that it improves the survival rate of patients by reducing the expression of VEGF and MMP-2.

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Resumen La leishmaniasis tegumentaria en Bolivia es producida mayoritariamente por L. braziliensis. Las manifestaciones clínicas son ulceras, que pueden generar lesiones satélites próximas a la inicial. Las drogas de primera elección para el tratamiento son los antimoniales pentavalentes; aunque con una eficacia variable. La falta de respuesta a estas drogas, induce al empleo de otras, consideradas como de segunda elección. Sin embargo, en todos los casos existe la posibilidad de falla terapéutica. El presente caso muestra la remisión de las lesiones usando tratamiento combinado de pentamidina, miltefosina y paromomicina, en un paciente con antecedente de falta de respuesta a la monoterapia con Glucantime®. La remisión de la enfermedad alcanzada al final de la terapia, probablemente sea resultado de la acción lítica simultánea de las tres drogas utilizadas y a la restauración de la respuesta inmune del paciente. Hasta los 21 meses de control pos tratamiento, todas las lesiones se mantuvieron cicatrizadas y ausencia de otras nuevas.

Abstract The tegumentary leishmaniasis in Bolivia is mainly caused by L. braziliensis. The clinical manifestations are ulcerative lesions which can generate satellite lesions close to the initial one. The first choice drugs for treatment are pentavalent antimonials; although with variable effectiveness. Lack of response to these drugs leads to the use of other alternatives, considered as second-choice drugs. However, in all cases there is the possibility of therapeutic failure. The present case shows the remission of the lesions using a combined treatment of pentamidine, miltefosine and paromomycin, in a patient with a history of lack of response to monotherapy with Glucantime® The remission of the disease achieved at the end of combined therapy is probably the result of the simultaneous lytic action of the three drugs used and the restoration of the patient's immune response. Up to 21 months of post-treatment control, all the lesions remained healed and the absence of new ones.

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Abstract This study assessed the performance of two pilot units, a conventional activated sludge (CAS) and an Integrated Fixed-Film Activated Sludge (IAS), in the treatment of leachate from sanitary landfill combined with domestic sewage, with the aim of removing organic substances. In order to assess the possible impacts on treatment, three experimental phases were designed using influent leachate contributions of 5%, 10%, and 20% of the total BOD load. Overall, the results showed that no significant changes in the behavior of biological processes. The IAS unit presented average BOD removal efficiencies of above 88%, 87% and 80% for the three leachate load contributions of 5%, 10% and 20% studied. The CAS unit presented lower average efficiency with a 5% leachate contribution (64%), but displayed a similar performance to the IAS unit in the other phases (82% and 80%); similar quantitative aspects were observed for both treatment processes with regards to biomass composition analysis. The kinetic coefficients related to heterotrophic metabolism did not indicate negative effects on treatment efficiency as a result of the increase in leachate addition, with values of 2.8; 2.8 and 2.7 d-1 obtained respectively for each phase with the CAS unit, and 2.0; 1.5 and 1.6 d-1 with the IAS unit, representing similar values to those found in the literature (1.5 a 5.0 d-1). The results reinforced the conclusion that the leachate load introduced did not cause inhibition or significant alterations to heterotrophic metabolism, and, therefore, to the removal of organic matter.

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Abstract Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032). Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.

Resumo Objetivo Avaliar os fatores associados à necessidade de insulina como tratamento complementar à metformina em gestantes com diabetes mellitus gestacional (DMG). Métodos Um estudo caso-controle foi realizado de abril de 2011 a fevereiro de 2016 comgestantes portadoras de DMG que necessitaram de tratamentos complementares além de dieta e exercícios físicos. Aquelas tratadas commetformina foram comparadas com aquelas que, além da metformina, também precisaram de combinação com insulina. Foram avaliadas as características maternas e de controle glicêmico. Modelos de regressão logística multinomial foram construídos para avaliar a influência das diferentes terapias nos desfechos neonatais. Resultados Foram avaliadas 475 gestantes que necessitaram de terapia farmacológica. Destas, 366 (77,05%) utilizaram terapia única com metformina, e 109 (22,95%) necessitaram de insulina como tratamento complementar. Na análise da razão de possibilidades (RP), a glicemia de jejum (GJ)<90mg/dL reduziu as chances de necessidade da combinação (RP: 0,438 [0,235-0,815]; p=0,009), bem como a primiparidade (RP: 0,280 [0,111-0,704]; p=0,007). Em gestantes obesas, foi observada uma chance maior de necessidade da combinação (RP: 2.072 [1.063-4.039]; p=0,032). Conclusão A obesidade resultou em um aumento na chance de a mãe precisar de insulina como tratamento complementar à metformina, enquanto a GJ<90 mg/dL e a primiparidade foram fatores de proteção.

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AIM: To assess prescription patterns for treatment of type 2 diabetes (T2D) and their outcomes in the IDMPS survey in Argentina. METHODS: Data from 2551 people with T2D recruited from 210 physicians participating in IDMPS surveys in Argentina (2006 to 2012 waves) were recorded, including medical history, medications, glycemic control, blood pressure, and lipid status. RESULTS: Most people were treated with oral glucose-lowering drugs (OGLDs) (65%), followed by combinations of these drugs plus insulin (22%) and only insulin (13%). These percentages varied according to T2D duration, the frequency of OGLDs decreasing while contrastingly and only insulin increasing (under 5 years versus over 10 years of disease duration, respectively). Average systolic blood pressure (SBP), HbA1c and LDL-c were significantly higher in patients treated with insulin either alone or associated with OGLDs. The percentage of people at target values for these parameters was also lower in these two groups. The percentage of people that reached simultaneous goal treatment values for BP, HbA1c and LDL-c levels was markedly low. CONCLUSION: Prescription patterns for treatment of T2D follows a chronological trend and the percentage of people at goal values (HbA1c, BP and LDL-c values) was significantly lower in people receiving insulin. These data must be carefully considered by health and academic authorities in order to implement effective strategies to modify this situation.

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La investigación sobre Tratamientos Combinados (TC) se ha centrado en estudiar los criterios que utilizan los profesionales a la hora de implementar este tipo de abordaje, pero son escasas las investigaciones que permitan conocer la perspectiva del paciente respecto a este tipo de tratamiento. Este es un estudio exploratorio, cualitativo conformada por 49 sujetos, residentes en CABA y GBA, que han recibido TC en los últimos dos años o lo están recibiendo en la actualidad, con el fin de evaluar los siguientes aspectos: 1) orientación teórica de profesionales; 2) comunicación entre profesionales; 3) efectos adversos de los tratamientos; y 4) experiencias de los pacientes respecto al TC. Los resultados preliminares sugieren que los pacientes en su mayoría conocen el tipo de tratamiento que realizan los psicólogos, siendo mucho menor el porcentaje de pacientes que conoce el tratamiento aplicado por su psiquiatra. En lo que respecta a informar los efectos adversos de los tratamientos son los psiquiatras quienes lo hacen en la mayoría de los casos pero es alta la cifra de pacientes que no han recibido esta información de ningún profesional tratante. Los pacientes presentan mayormente experiencias positivas respecto al TC basadas principalmente en la potenciación de los tratamientos y la contención de ambos profesionales. En lo que concierne a las experiencias negativas, la mala comunicación entre profesionales es la característica destacada. Este estudio se encuentra en proceso y sus conclusiones son provisionales.

Research on Combined Treatment (CT) is based largely on studies that seek to explore the criteria used by professionals involved in the combined therapies, though, there is little research exploring the perspective of CT users. We perform an exploratory qualitative study. A questionnaire was administered to 49 patients from CABA and GBA that are having CT or had been received it during the last two years to assess the following aspects: 1) professional´s theoretical orientation; 2) communication among professionals; 3) Side effects of treatments; and 4) patient experience regarding CT. Preliminary results suggest that most patients know the type of treatment carried out by psychologists, being lower the percentage of patients who know the psychiatric treatment. Regarding providing information about treatments side effects, psychiatrists reported in most cases, but there is a high number of patients who have not received this information from any treating professional. Concerning patient´s perspective on CT, the majority have positive experiences, being highlighted the empowerment of both treatments and professional care. On the other hand, bad communication between treating professionals were emphasized among negative experiences. This study is ongoing so its conclusions are tentative.

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Actualmente, la aplicación de TC tiene evidencia a favor para una importante cantidad de trastornos mentales. Sin embargo, aún no hay estudios acerca del trabajo interdisciplinario que deben llevar a cabo psicólogos y psiquiatras en un TC. El objetivo del presente estudio fue conocer las variables que favorecen y obstaculizan la comunicación entre psiquiatras y psicólogos clínicos dentro de un TC, en la Ciudad autónoma de Buenos Aires. Se trata de un estudio exploratorio-descriptivo, de análisis cualitativo. La muestra estuvo compuesta por 10 psicólogos clínicos y 10 psiquiatras, a quienes se les realizó una entrevista y se trabajó con viñetas clínicas. Los resultados muestran que si bien, tanto psicólogos y psiquiatras, indicaron comunicarse con el otro profesional, parecería que los psicólogos lo realizan con mayor frecuencia. Por otro lado, se observó que en general los profesionales suelen comunicarse ante situaciones de urgencia, aunque más de la mitad refiere no tener un plan de acción acordado para casos de emergencia. Los participantes que afirmaron tener un plan de acción, compartían el lugar de trabajo con el otro profesional.

Recently, there is evidence for the combined treatment for a considerable number of mental disorders. However, the interdisciplinary task of clinical psychologists and psychiatrists that make combined treatment possible lacks of appropriate study. The aim of this study is to know aspects that improve and as wells as those that obstruct the communication between clinical psychologists and psychiatrists in the context of the combined treatment that have place in Buenos Aires city. This is a descriptive-exploratory study with a qualitative analysis. The sample is compound by 10 clinical psychologists and 10 psychiatrists, to whom it applied an interview with clinical vignettes. The results indicated that clinical psychologists and psychiatrists said that they tried to communicate with his or her colleagues; it seemed that clinical psychologists tried to communicate more frequently. Besides, it observed that both professionals tried to communicate in emergency situations. However, a half of the sample referred that they have not a protocol accorded to emergency. Those who said having a protocol share the setting with the other professional.

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Se presentan los resultados de un proyecto de investigación clínica desarrollado en la Dirección General de Salud y Asistencia Social, UBA, que evaluó la eficacia terapéutica en el tratamiento del ataque de pánico. Para ello se compararon dos modalidades terapéuticas: Psicoterapia Focal de Orientación Psicoanalítica (POP) y Tratamiento Combinado (TC) -POP y Tratamiento Psicofarmacológico-. La muestra fue constituida por 55 sujetos con trastorno de pánico, según los criterios del DSM-IV TR, que recibieron aleatoriamente uno u otro tratamiento durante 12 sesiones a razón de una sesión semanal. Los resultados obtenidos demostraron que POP y el TC constituyen modalidades de intervención eicaces en el tratamiento del trastorno de pánico permitiendo reducir la sintomatología del mismo, mejorar la calidad de vida del paciente y mantener los resultados en el largo plazo. POP favorece la adherencia al tratamiento farmacológico. El TC no mostró diferencias significativas respecto de POP con relación a su eficacia.

We are presenting the conclusions of a clinical research project developed by the General Directorate for Health and Social Assistance, UBA, which assessed the therapeutic eficacy in the treatment of a panic attack. The results were based on the comparison of two therapeutic modalities: Focal Psychoanalytically Oriented Psychotherapy (POP) and Combined Treatment (TC) - POP and Psychopharmacological Treatment. The sample group was comprised of 55 subjects with panic disorder (based on DSM-IV TR panic disorder diagnosis) who randomly received one or another weekly treatment during a period of 12 weeks (one session per week). The results showed that POP and the TC are effective intermission methods for the treatment of panic disorder, the ability to reduce the symptoms, improve the quality of life of the patient, and maintain long term results. POP favors adherence to pharmacological treatment. The TC showed no significant differences with regard to POP with relation to its eficacy.

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The experiments performed in this study consisted of 16 batch reactors fed different mixtures of landfill leachate combined with synthetic wastewater treated using the Powdered Activated Carbon Treatment (PACT) process. The objective was to measure the COD mass removal per liter each day for each reactor using two models: the first model combined the variables PAC concentration (0 g·L(-1), 2 g·L(-1), 4 g·L(-1), and 6 g·L(-1)) and leachate rate in the wastewater (0%, 2%, 5%, and 10%), and the second model combined the PAC concentration and the influent COD. The Response Surface Methodology with Central Composite Design was used to describe the response surface of both models considered in this study. Domestic wastewater was produced under controlled conditions in the laboratory where the experiments were performed. The results indicated that the PAC effect was null when the influent did not contain leachate; however, as the concentration of leachate applied to the mixture was increased, the addition of a higher PAC concentration resulted in a better COD mass removal in the reactors. The adjusted R(2) values of the two models were greater than 0.95, and the predicted R(2) values were greater than 0.93. The models may be useful for wastewater treatment companies to calculate PAC requirements in order to meet COD mass removal objectives in combined treatment.

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El tratamiento combinado (TC) de la fobia social o trastorno de ansiedad social es frecuente en la práctica clínica. Sin embargo, la evidencia acerca de su superioridad sobre la psicoterapia o la farmacoterapia administradas en forma de monoterapia no está clara. En los últimos años se han publicado estudios clínicos que evalúan la eficacia del TC en la fobia social. En este artículo se realiza una revisión sistemática de estudios clínicos sobre el TC de la fobia social a través de las bases de datos: EBSCO, PubMed, Cochrane Collaboration y el Portal de Búsqueda de la Biblioteca Virtual en Salud. Se hallaron 8 estudios controlados y aleatorizados. En la mayoría de los estudios clínicos se observó una superioridad del TC sobre la monoterapia, sea psicoterapéutica o farmacológica. Se discuten estos hallazgos en función de las limitaciones metodológicas de los estudios clínicos encontrados y las sugerencias clínicas que de ellos pueden extraerse. Se concluye que existe evidencia acerca de la superioridad del TC sobre la monoterapia en el tratamiento de la fobia social aunque se sugiere cautela en la generalización de esta conclusión.

Combined treatment (CT) for patients with social anxiety disorder or social phobia is quite common in clinical practice. However, the superiority of TC over psychotherapy and/or pharmacotherapy as monotherapy is still not clear. Over the last few years, several clinical studies that evaluate the efficacy of CT in social phobia have been published. A systematic review of clinical studies about CT in social phobia was carried out in this article in the following database: EBSCO, PubMed, Cochrane Collaboration and the “Portal de Búsqueda de la Biblioteca Virtual en Salud”. We found 8 randomized controlled studies. There is a superiority of CT over monotherapy in most of them, either psychotherapeutic or pharmacologic. We discuss these findings in terms of the methodological limitations of all clinical studies found, and based on clinical suggestions derived therefrom. Given this, it is concluded that there is evidence about the superiority of CT over monotherapy in social phobia treatment, although caution in generalizing this conclusion is suggested.

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El tratamiento combinado (TC) de la fobia social o trastorno de ansiedad social es frecuente en la práctica clínica. Sin embargo, la evidencia acerca de su superioridad sobre la psicoterapia o la farmacoterapia administradas en forma de monoterapia no está clara. En los últimos años se han publicado estudios clínicos que evalúan la eficacia del TC en la fobia social. En este artículo se realiza una revisión sistemática de estudios clínicos sobre el TC de la fobia social a través de las bases de datos: EBSCO, PubMed, Cochrane Collaboration y el Portal de Búsqueda de la Biblioteca Virtual en Salud. Se hallaron 8 estudios controlados y aleatorizados. En la mayoría de los estudios clínicos se observó una superioridad del TC sobre la monoterapia, sea psicoterapéutica o farmacológica. Se discuten estos hallazgos en función de las limitaciones metodológicas de los estudios clínicos encontrados y las sugerencias clínicas que de ellos pueden extraerse. Se concluye que existe evidencia acerca de la superioridad del TC sobre la monoterapia en el tratamiento de la fobia social aunque se sugiere cautela en la generalización de esta conclusión. (AU)

Combined treatment (CT) for patients with social anxiety disorder or social phobia is quite common in clinical practice. However, the superiority of TC over psychotherapy and/or pharmacotherapy as monotherapy is still not clear. Over the last few years, several clinical studies that evaluate the efficacy of CT in social phobia have been published. A systematic review of clinical studies about CT in social phobia was carried out in this article in the following database: EBSCO, PubMed, Cochrane Collaboration and the ôPortal de Búsqueda de la Biblioteca Virtual en Saludö. We found 8 randomized controlled studies. There is a superiority of CT over monotherapy in most of them, either psychotherapeutic or pharmacologic. We discuss these findings in terms of the methodological limitations of all clinical studies found, and based on clinical suggestions derived therefrom. Given this, it is concluded that there is evidence about the superiority of CT over monotherapy in social phobia treatment, although caution in generalizing this conclusion is suggested. (AU)

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Objetivo: Determinar la supervivencia libre de enfermedad y global a dos años en pacientes con cáncer gástrico que recibieron tratamiento adyuvante en el Instituto Nacional de Cancerología de Colombia (INC) durante el 2009. Pacientes y métodos: De forma retrospectiva, se incluyeron pacientes con diagnóstico de adenocarcinoma gástrico o de la unión gastroesofágica que hubieran recibido quimioterapia adyuvante en el INC durante el 2009. Se describieron las características clínicas, epidemiológicas, tratamiento recibido, supervivencia global y libre de enfermedad a dos años. Resultados: Se incluyeron en el análisis a 32 pacientes. La edad media fue de 55 años. Los hombres representaron el 56,2% de los casos. El subtipo histológico predominante fue el intestinal (53,1%). El grado de invasión tumoral T3-T4 se presentó en el 81,2%, y el compromiso ganglionar, en el 84,3%, con 34,3% de los casos, con siete o más ganglios comprometidos. El 96,8% recibieron tratamiento adyuvante de acuerdo con el protocolo Macdonald. El 75% de los pacientes completaron el tratamiento. En el 12% de los casos se suspendió el tratamiento por toxicidad. El seguimiento medio de los pacientes fue de 37,8 meses. La supervivencia global y libre de enfermedad a dos años en pacientes que recibieron quimioterapia adyuvante fue de 85,18% y 77,4%, respectivamente. Conclusiones: El estudio mostró una mayor supervivencia global y libre de enfermedad para pacientes que recibieron tratamiento adyuvante en el INC frente a la encontrada en los estudios INT 0116 y MAGIC; la supervivencia es similar a estudios con población asiática.

Objective: To determine the disease free and overall survival at two years in patients with gastric cancer who received adjuvant treatment in the Colombian National Institute of Cancerology (INC) during 2009. Patients and methods: A retrospective study was conducted on patients with a diagnosis of a gastric adenocarcinoma or of the gastroesophageal junction and who had received adjuvant chemotherapy in the INC during the year 2009. The variables recorded were: clinical and epidemiological characteristics, treatment received, and the overall and disease free survival at two years. Results: A total of 32 patients (56.2% males), with a mean age of 55 years were included in the analysis. The most predominant histological sub-type was intestinal (53.1%). T3-T4 tumor invasion grade was present in 81.2%, and lymph involvement in 84.3%, with 34.3% of cases with seven or more lymph nodes involved. Almost all of them (96.8%) received adjuvant treatment according to the Macdonald protocol. Three-quarters (75%) of the patients completed the treatment. Treatment was stopped in 12% of cases due to toxicity. The mean follow-up of the patients was 37.8 months. The overall and disease free survival was at two years in the patients who received adjuvant chemotherapy was 85.18% and 77.4%, respectively. Conclusions: The study showed a greater overall and disease free survival in patients who received adjuvant treatment in the INC compared to that found in patients in the INT 0116 and MAGIC studies. The survival is similar to that in studies with Asiatic populations.

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